Perm Medical Journal

Sarcomatoid carcinoma is a variant of carcinoma arising in various locations, the cells of which have acquired a mesenchymal phenotype. This feature of tumor progression contributes to more rapid invasion into surrounding tissues and early metastasis, leading to a poorer prognosis for patients with this type of tumor. Current information on sarcomatoid carcinoma is mainly presented in the form of individual case reports. This article summarizes current knowledge on the mechanisms underlying sarcomatoid carcinoma development, in particular the role of epithelial-mesenchymal transition, as well as the histological, immunohistochemical and genetic characteristics of sarcomatoid carcinoma. The article also addresses the tumor microenvironment and its role in the pathogenesis of epithelial-mesenchymal transition and tumor progression. The relationship between sarcomatoid carcinoma cells with cancer stem cells is considered.

An overview of various diseases described by James Paget and named after him is presented. These include Paget's disease of bone, Paget's disease of the breast, Paget-Schroetter syndrome. The least known of these is Paget-Schroetter syndrome, which refers to primary deep vein thrombosis of the upper extremity. It most commonly develops in young men after prolonged intense physical activity involving the shoulder girdle.

The presented review of the diseases (syndromes) described by the British surgeon and pathologist James Paget and named after him will allow physicians of various specialties to become familiar with this interesting and rare pathology and help in the diagnosis of these conditions.

Тo analyze current scientific publications dedicated to the problem of selecting dental base materials for prosthetics in patients with gastroesophageal reflux disease, published in literary databases such as eLIBRARY.RU, the Electronic Library of Dissertations of the Russian State Library, National Institutes of Health (NIH), PubMed, and Medline. The search depth is 15 years.

Gastroesophageal reflux disease (GERD) represents a significant medical problem, with a prevalence among the adult population in Russia ranging from 23 to 46 %. This condition is more commonly observed in women, with an incidence rate of 13.9 %, while among men it reaches 12.5 %. The increase in GERD prevalence also correlates with age, highlighting the need for a careful approach to the diagnosis and treatment of this disease.

Dental manifestations of GERD are diverse and can significantly impair the quality of life for patients. These include erosions of the hard dental tissues, wedge-shaped defects, pathological tooth wear, and hypersensitivity. Additionally, chronic generalized periodontitis and changes in the oral mucosa are also frequent accompanying symptoms, necessitating a comprehensive approach to dental treatment for these patients.

The selection of base materials for dental constructions in patients with GERD should be based on several key requirements. Among the most important are chemical inertness and resistance to aggressive environments, which ensure the durability and safety of the materials used. Thermal stability, absence of toxic substances, resistance to enzymes and acidity, as well as high adhesive properties are mandatory characteristics. Furthermore, strength, hygiene, aesthetic qualities, increased acid resistance, and biocompatibility of materials play a crucial role in successful prosthetics.

The specifics of prosthetics in patients with GERD also require special attention. Reduced lifespan of prosthetics, frequent pain sensations, and the risk of dislodgment of constructions are primary issues that must be considered. Equally important is the consideration of altered oral microflora, which may influence the choice of materials and treatment methods. Thus, a comprehensive approach to diagnosing and treating GERD, taking into account dental manifestations and the peculiarities of prosthetics, is essential for successful therapy and improving patients' quality of life.

The research methodology includes analyzing epidemiological data, clinical manifestations of GERD, assessing the dental status of patients with GERD, and conducting a comparative analysis of the oral cavity condition in GERD patients versus healthy individuals. Statistical methods were employed for data processing.

The selection of base materials for patients with GERD requires a comprehensive approach. It is essential to consider the chemical inertness, acid resistance, and biocompatibility of materials. Adhesive properties, strength, hygiene, and aesthetic characteristics are also important. There is a need to develop specialized base materials for patients with GERD.

Objective. To analyze the clinical course of allergic rhinitis and conjunctivitis and the extent of drug therapy among smoking and non-smoking patients, and to estimate the need for antiallergic drugs in these patients during the grass pollen season using statistical modeling tools.

Materials and methods. The prospective observational study included 27 patients (7 of whom were smokers) aged 18–44 years with a confirmed diagnosis of hay fever and sensitization to grass pollen, examined during the exacerbation period from June 6 to July 26, 2023 (a total of 1,377 observations). A mixed model with fixed and random effects was developed to assess treatment need.

Results. It was established that during the exacerbation of hay fever, the symptoms of allergic rhinitis and conjunctivitis were more pronounced in smokers than in non-smokers, as assessed by symptom scores and the extent of therapy. A one-point increase in such symptoms as nasal discharge, nasal congestion, nasal itching, and eye itching was associated with a higher probability of taking antiallergic drugs. Smokers of conventional cigarettes had a 10.7-fold higher need for therapy.

Conclusions. The constructed mixed model showed that smoking conventional cigarettes increases the need for antiallergic drugs in patients with sensitization to grass pollen during exacerbation of hay fever.

Objective. To develop and validate a tool for assessing dental patient compliance. A critical component in improving the health of a modern patient, especially those with chronic conditions, is his adherence to treatment and compliance with medical recommendations, which is reflected in his level of compliance. This characteristic of a dental patient can be crucial in achieving and maintaining treatment outcomes, which can be both prolonged and costly. This necessitates the use of tools to assess the level of dental patient’s compliance and, subsequently, technologies for its improvement.

Materials and methods. The study design was a psychometric assessment of a dental patient compliance questionnaire. The preliminary version of the questionnaire was developed using the Delphi method with the participation of 17 experts who evaluated its content validity. The clarity of the wording was assessed both by experts and by the Flesch Reading Ease readability index. Internal consistency of the questionnaire was assessed using Cronbach's alpha and item-total correlation (I-TC). Factor analysis was performed to identify the questionnaire`s subscales. Reliability was assessed using the test-retest method with calculation of Pearson correlation coefficient (r). The sensitivity of the instrument and its applicability were evaluated in groups of patients undergoing dental treatment with or without the use of compliance- enhancing technologies.

Results. The preliminary version of the questionnaire, developed by experts, consisted of 51 statements, the Flesch Reading Ease score was 43 [36; 54]. During internal consistency assessment, the questionnaire was reduced to 45 statements, and Cronbach's alpha for the final version was 0.91. The reliability of the questionnaire, as assessed by Pearson`s correlation coefficient, was 0.86. Sensitivity testing proved its ability to detect changes in the level of compliant behavior depending on external factors.

Conclusions. The proposed dental patient compliance questionnaire is a specialized, valid tool for assessing the level of adherence to dental health. It opens up opportunities for cooperation between the patient and the dentist to achieve the maintenance of both oral health and systemic health in general.

Objective. To evaluate the impact of paroxysmal atrial fibrillation (AF) during the development of ST segment elevation myocardial infarction (MI) on the prognosis of patients during long-term follow-up.

Materials and methods. The study presents the results of the second stage (outpatient) of a prospective, two-stage, open-label, observational clinical trial. To assess the contribution of AF to the unfavorable prognosis of patients with ST-segment elevation MI, patients were divided into two groups. The first group included 42 patients (36.8 %) with ST-segment elevation MI without AF during hospitalization and in their medical history; the second group included 72 patients (63.2 %) with ST-segment elevation MI and paroxysmal AF during the index hospitalization for MI. To register an unfavorable prognosis, primary endpoints were determined - cardiovascular death associated with the development of recurrent MI, acute decompensation of chronic heart failure (ADHF), acute cerebrovascular accident (ischemic, hemorrhagic strokes, intracerebral hemorrhage, acute brain circulation disorders), as well as secondary endpoints: fatal recurrent MI, ADHF, stroke.

Results. The follow-up duration was 22.2 ± 4.5 months from the first day of the index hospitalization with ST-segment elevation MI. During the follow-up, permanent AF was registered in 12 (16.7 %) patients of the second group, persistent/paroxysmal AF was registered in 35 (48.6 %), and recurrent paroxysms were not registered in 25 (49.0 %) of 51 patients with newly diagnosed AF during ST-segment elevation MI. In the first group, AF was newly diagnosed in 4 (9.5 %) patients during the follow-up. During 2 years of follow-up, the incidence of the primary endpoint was statistically significantly higher in the group of patients with AF (p = 0.004), as were the number of patients with a fatal outcome (p = 0.004) and the incidence of fatal stroke (p = 0.020). In case of paroxysmal AF development in patients with ST-segment elevation MI during index hospitalization, the OR of fatal events during 2 years of observation increases by 3.877 times (95 % CI 1.508–10.195), RR – by 2.399 (95 % CI 1.285–4.941), the OR of the frequency of fatal events increases by 4.021 times (95 % CI 1.518–10.946), RR – by 2.553 times (95 % CI 1.305–5.569), the OR of cardiovascular death – by 4.334 times (95 % CI 1.095–19.951), RR – by 3.501 (95 % CI 1.077–14.636), the OR of fatal stroke – by 1.388 (95 %CI 1.367–1.442), RR – 1.328 (95 %CI 1.265–1.396). Univariate analysis showed that the development of paroxysmal AF during the index hospitalization with ST-segment elevation MI increased the Odds ratio of CV death developing during 2 years of follow-up by 3.637 times (95 % CI 1.071–12.351, p = 0.038). The incidence of fatal recurrent MI and ADHF did not differ between the groups.

Conclusions. During a two-year follow-up, 48.6 % of patients who had a STEMI and an episode of AF died from cardiovascular causes, which is 2.5 times higher than among those without rhythm disturbances (19.0 %) (p = 0.004). The development of paroxysmal AF during the index hospitalization with ST-segment elevation MI increases the odds ratio for the development of cardiovascular death over 2 years of follow-up by 3.637 times. The main cause of death in patients who had a STEMI with an episode of AF was stroke, the OR of which increased by 1.388 times, and the RR of which increased by 1.328 times. The incidence and timing of fatal recurrent MI and ADHF were not associated with paroxysmal AF in patients with ST-segment elevation MI.

Objective. To evaluate the acceptability of the analytical characteristics of the Snibe system for the reference values of the Beckman Coulter system and in the low-concentration range.

Materials and methods. Total prostate-specific antigen (PSA) concentration was measured using the Snibe analytical system (MAGLUMI 2000 Plus automated immunochemiluminescence analyzer; MAGLUMI Total PSA (CLIA) in-vitro reagent kit for quantitative determination of total PSA by immunochemiluminescent analysis on MAGLUMI automated analyzers; WHO 96/670 calibrator) and the Beckman Coulter analytical system (Access 2 automated immunochemiluminescence analyzer; Access Hybritech PSA reagent kit; Access Hybritech PSA calibrators).

In the first phase of the study, blood serum samples, the three-level control material Lyphochek Tumor Marker Plus Control (Bio-Rad), and control samples from the Bio-Rad External Quality Assurance Services (EQAS) program were used to assess precision and relative accuracy. The standard measurement uncertainty (u) was assumed to be equal to the coefficient of variation under EQAS reproducibility conditions, consistent with the within-laboratory long-term inter-series coefficient of variation.

The material of the second phase of the study was blood serum samples from 93 men. Blood was collected between 7.00 and 10.00 a.m. on an empty stomach. Serum was separated by centrifugation at 3000 rpm for 10 minutes. The concentration was measured in primary vacuum tubes on the day of blood collection.

Statistical analysis was performed using "Statistica 10.0" software (license AXA009K287210FAACD-B). Statistical significance was set at p <0.05. When describing the data obtained, arithmetic mean (M), standard deviation (SD), median (Me), minimum and maximum values were indicated. To compare results obtained with the two analytical systems, the following methods were used: Pearson correlation coefficient (r) to assess the strength and direction of linear association, mean coefficient of variation as a relative measure of difference between paired measurements; Passing-Bablok regression analysis to identify constant and proportional bias, Bland-Altman consistency analysis to quantify agreement in clinically relevant concentration ranges; and a 2x2 contingency table to assess the effect of bias on clinical interpretation.

Results. In the clinically relevant range of 1–10 ng/mL, presenting results as a concentration interval that incorporates the expanded measurement uncertainty of both analytical systems ensures their comparability when assessed against the population reference interval (< 4.0 ng/mL). However, for individual monitoring and decision-making based on specific thresholds, the identified bias must be taken into account. The Snibe-WHO analytical system shows low precision when measuring trace amounts of PSA (up to 141 % under repeatability conditions), which limits the possibilities of laboratory monitoring of patients after radical prostatectomy.

Conclusions. The data obtained in our laboratory served as the basis for establishing the standard measurement uncertainty for BC-Hybr as 9.4 % in the concentration range <0.1 ng/mL (conventionally underestimated, according to repeatability precision data) and increasing the lower limit of quantitation for Snibe-WHO to 0.1 ng/mL.

Objective. To identify the characteristics of the HIV epidemic process in the Volga Federal District (VFD) during the pandemic spread of the novel coronavirus infection (NCI).

Materials and methods. Statistical analysis of indicators characterizing the epidemic process of HIV infection and COVID-19 was performed using the data from Federal State Statistical Observation Form No. 4 “Information on Blood Test Results for HIV Antibodies”, the departmental monitoring form of Rospotrebnadzor “Information on Measures for the Prevention of HIV Infection, Hepatitis B and C, and on the Detection and Treatment of HIV-Infected Patients”, information from the Rospotrebnadzor corporate portal, data provided by the territorial centers for the prevention and control of AIDS and infectious diseases of the Volga Federal District, and data from the Rospotrebnadzor Departments of the constituent entities of the Volga Federal District.

Results. Quarantine measures implemented in 2020 to prevent an exponential increase in COVID-19 incidence led to a decrease in HIV testing coverage among the population of the Volga Federal District and, consequently, a reduction in the number of newly diagnosed HIV cases. The growth rate of newly registered HIV cases was negative (– 24.6 %). The gradual lifting of COVID-19 restrictions subsequently led to an increase in the HIV testing coverage in the district's population. However, from 2020 to 2024, the HIV detection rate decreased. Each year, there was an increase in antiretroviral therapy (ART) coverage among HIV-infected individuals under follow-up, which reduced the risk of HIV-related death. HIV mortality and incidence rates fluctuated slightly during the analyzed period, indicating no association between the epidemic processes of COVID-19 and HIV infection.

Conclusions. This study revealed specific features of the HIV epidemic process in the Volga Federal District during SARS-CoV-2 virus circulation.

The evaluation of the effectiveness of the Limberg flap in the treatment of trophic ulcers in patients with type 2 diabetes mellitus was carried out.

The Limberg flap plays an important role in the comprehensive treatment of trophic ulcers in patients with diabetes mellitus. This method allows closure of deep wounds and accelerates ulcer healing by using a tissue flap from an adjacent area. Treatment effectiveness is assessed by wound appearance, healing rate, preservation of foot function, and the patient's satisfaction with the surgical outcomes.

A clinical case of treating a trophic ulcer on the plantar surface of the left foot in a patient with type 2 diabetes mellitus demonstrates the effectiveness of the Limberg flap, as confirmed by positive results in all assessment criteria: improved wound appearance, accelerated healing, preserved foot function, and high patient satisfaction with the treatment outcome.